In December, 1987 it was necessary to perform a coronary artery bypass graft involving four vessels on the author of this essay. The surgery was performed at New York Presbyterian Hospital and was accomplished by a mixed Jewish and Irish team followed by recovery where I was attended to by some of New York’s finest Catholic nurses. I have to remind myself that the whole function took place in a Presbyterian Hospital. I suppose that if anything untoward happened to me, such as death, I would be covered across the board as I prepared to enter Paradise. In this respect, I favor the Muslim martyrdom approach which rewards martyrs with fine wine, winsome girls and Cuban cigars. Ah, but recovery was soon achieved so I will have to think longer about the Muslim rewards of martyrdom.
Since my discharge from what is referred to in Cardiology-speak as CABGx4, exercise has been my constant companion. Walking, bicycle riding, a treadmill and an indoor bike, a rowing machine and extensive work on this half acre lot gives plenty of exercise. As winter gives way to spring, my wife, the lovely Miss Chicka, and I often walk four miles on our street which carries light traffic.
So it was this week that about a half mile into our walk, we passed an elderly gentleman using a cane with four legs on its end who made it clear that he wanted to converse with us. He was well dressed and was simply standing in the street in front of a very fine home about four or five blocks away from our home. So we crossed the street to converse with the man. He soon told us that he was recovering from a broken hip which I suppose accounted for the cane or walker. As part of the little conversation, he said he was 78 years old. Remember that.
It was obvious that he had some trouble speaking and I noticed that he was drooling slightly. When he tried to tell us of his other problem, he said he had forgotten the name of the disability. To prod his memory and with the thought that he was showing slight drooling, I said maybe the word he was looking for was “stroke.” The gentleman said, “Yeah, Yeah, That’s the word. That’s what I had.”
So now old Ed Carr gets a little snookered. I said that he shouldn’t worry about the stroke as I was getting along pretty well even though two strokes had been in my medical history. And I told him that this summer, I expect to turn 80 years of age. Without batting an eye, he said he couldn’t believe my age, as I “was a young, vigorous, good looking guy.” While I was eating up this compliment, fully deserved I might add, the man said he was about to turn 80 himself on his next birthday. So 79 would be his next anniversary, according to the Treaty of Geneva. Earlier he had said he was 78 years old. I let that one pass because I know how a stroke can injure or destroy one’s mathematical expertise. And what difference does it make if he is 79 or 80 or 81 years of age.
After a while, Judy and I excused ourselves and resumed our walk. The old gentleman wished us well and in return he was told to “stay strong” which is what I generally say when finishing letters or in ending conversations. Our friend said he would stay strong.
That encounter set my mind to enumerating the various effects that stroke victims are likely to encounter. I’m not much of an example to tell anyone how to avoid a stroke having had one in 1992 and a second severe one in late 1997. So about all this poor example can say is eat right, don’t smoke, get some exercise and hope for the best. So all that can be done is to give the reader a thought or two about the effects of a stroke assuming you are so unlucky as to have had one.
My stroke experience started on a Saturday evening after all the work and exercise had been completed. I shaved and took a shower in preparation for dinner and a good bottle of wine. When I emerged from the shower and tried to get the towel behind my back to dry there, the left arm failed to work properly. The arm didn’t bend and the hand could not grasp the towel. There was no pain at all. Nothing like having a tooth extracted or falling down and spraining a wrist. Nothing. When the failure persisted for two or three minutes, it seemed to me that a stroke had taken place. So Judy called the Emergency Room at Overlook Hospital and by the time we drove there, Dr. Slama from the Summit Medical Group was on his way to the hospital soon to be joined by a neurologist, also from Summit. After perhaps 24 hours, Slama and his neurological partner concluded that my problem was a TIA – a Transient Ischemic Attack. Hospitalization at Overlook lasted seven or eight days. During that time, I had a steady diet of Coumadin, the drug that prevents clots from forming which block passageways to the brain. After perhaps 36 hours, the arm and the hand returned to normal operation. Upon discharge, there was a meeting with cardiologists, neurologists, nurses and Summit Medical Group’s representative to Overlook Hospital at which time I was given a “Medic Alert” tag for my wrist and told that Coumadin would be required for the rest of my life. That seemed like a fair enough arrangement to me.
So from July, 1992 when the TIA occurred, I often found myself in the lab at the Summit Medical Group to draw blood to determine the Coumadin content in the blood. This occurred every two to four weeks. Drawing blood was not a happy experience, particularly when the phlebotomist was a little clumsy. But that was not a big deal. I was still alive and stroke free.
That situation went on until December, 1997. In tests during the Fall of 1997, my regular cardiologist Andrew Beamer, told me that my aortic valve was greatly restricted. Normal ones have an opening approaching the size of a quarter. Mine had shrunk to less than the diameter of a dime so it had to be fixed. I had trouble breathing particularly after exercise. So arrangements were made with the Mid-Atlantic Surgical Associates in Morristown with a fellow that Andy Beamer recommended. His name is Albert Casale. Casale gave me almost two hours in the pre-operative interview. He explained how he had to avoid the by-pass grafts as he opened my chest for another major operation. Avoiding the grafts is no small accomplishment when the surgeon is using an electric saw to open the chest. Al Casale is a very skilled surgeon and a regular guy. I like him.
Coumadin inhibits work on the heart because of the non-clotting effect on blood. So in accordance with standard instructions for aortic valve operations, I was instructed to take no Coumadin for the five days prior to the planned surgery. On the fourth day without Coumadin, Judy and I spent four or five hours raking leaves and carting them to the street from our large backyard. I was to enter the hospital for surgery the next morning.
After the work in the yard, I took a shower and the bed had to be made. While we were trying to get the bedclothes in place, Judy looked at me and announced that I was having a stroke.¹ My attitude was: “Who? Me?” I had no pain that I can recall but I suppose I must have been so uncoordinated that Miss Chicka gave her instant diagnosis and seemed to brook no questions or dissent. When the Rescue Squad came to the house, along with the Overlook Hospital Emergency representatives, they quickly agreed with Miss Chicka’s diagnosis. So it was off to Overlook Hospital for a more than two week period of recovery.
After about eight or nine hours in the Emergency Room, I found myself in a small ward with several other stroke victims – most of whom were much worse off than I was. The next morning, a therapist or nurse came to my bed with a little jar of pudding which she fed me. I did not know it at the time, but this was to determine whether the stroke victim could swallow or could swallow without complications. My swallowing seemed alright and I then began to petition for the right to use the bathroom. Soon that privilege was granted and then the hospital found a private room that made things somewhat easier.
This stroke seemed to do nothing in terms of damage to any of my limbs. The effects were concentrated in my brain. On many-many occasions, I have said that when a thought forms in the stroke victim’s brain, it is very difficult or impossible to make that thought come out of the mouth or to the hand so that it can be written. This is called Aphasia. The morning after the stroke occurred I could only say “Thank you” and somehow I could write my name and print “six” and “seven.” Printing those numbers was the old draftsman at work. It got better after awhile, but I was concerned that it would be necessary for me to use “Thank you” as my entire English vocabulary.
Now here is a thought if you know anyone suffering a stroke. Two or three women who were on the staff of the hospital visited me quite often in my room insisting that I agree to use their rehabilitation services. Among other things, they gave me word exercises and told me that I would have to memorize names of things and spit them out in 30 seconds or less on demand. If I could do this feat, it meant I had recovered from the stroke. One example had to do with vegetables. Another had to do with makes of automobiles. I had to think up the names of cars when I could barely call my own name, and recite a list of 20 car makes in 30 or 35 seconds. People suffering from Aphasia have a particularly difficult time recalling nouns, hence the veggies and cars.
By this time, Judy and I had already determined that these women were charlatans and that the Kessler Rehabilitation Center would have me as a patient. Even when the women were told that fact, they kept on insisting that I use their services, much to my annoyance. So if you know a stroke patient, advise them not to agree to a therapist who just happens to find his or her room at the hospital. If the patient is in the New York or Philadelphia general vicinity – GO TO KESSLER. Got that? Go to Kessler. Or alternatively, go to see Dr. Martha Taylor Sarno of the Rusk Institute located at 400 East 34th Street in New York City.
And if the patient had a stroke like mine affecting only the brain and not involving the arms and legs or other parts of the body, when you get to Kessler ask to see Shirley Morganstein, Director of Speech Therapy. Perhaps she will again prescribe essay-therapy, as in my case. Writing essays has been the absolutely most effective rehabilitative practice to come to my attention. At first, it ain’t easy. Be prepared to sit at your desk or table when in search of a word, the brain goes blank; it just goes on strike. In such a case like that look for synonyms or wait it out or go on to a different part of the essay, if that is possible.
Writing essays is not a one time complete fix. I find that without brain exercise, it tends to become flabby and slippage occurs. See my next paragraph, for example, on the ability to handle math problems. And so four and one half years after the stroke, I still try to write essays not necessarily because I love my words and prose, but rather because of the need to exercise what passes for a brain in my head. If it is not kept at work, it slips and deteriorates. But one more time, essay writing takes a lot of work. As I say, it ain’t easy, but I’m here to tell you that it is worth the effort. The alternative to this sort of work is not attractive at all.
Another effect of my stroke is its continuing effect upon my ability to handle mathematical problems. The other day at the bank, I gave the teller a $100 check to cash so that we could send $50 to a grandson for his 17th birthday. I also specified that I needed five one dollar bills in this transaction. The teller gave me the $50 bill, two $20 bills and a five and five ones. I knew that she was right because I saw her use her computer to see if the amount came to $100. But I was buffaloed. All the way to the car it seemed to me that I was missing something. I guess – guess – that the $20 dollar bills may have registered in my brain as $10 dollar bills. In the privacy of the car, I counted out the $100 that the teller had given me. But here I am four and a half years after the stroke largely unable to do small sums quickly. Think of this. In the 1960’s and 1970’s before hand held calculators were invented, I used to figure my New Jersey, New York State and New York City income taxes, all at once. Nobody said it was an easy task, but the job got done. In 2002, it would be largely impossible to handle that job. So math is a problem even figuring out my gas mileage. And when I am asked for my Social Security Number or my phone number, I sometimes go blank.
A second effect of strokes, at least in my case, has to do with the alphabet. Reading the alphabetized heading on the classified section of the phone directories is a struggle. Finding a name doesn’t come easily. When I read the stock tables, I look at where my stocks appear each day hoping that they have not moved. If, as has happened in the past, a merger occurs and the stock listing is moved, its one more struggle to figure out the alphabetical listing. I don’t own that many stocks and some of them are listing heavily to starboard – Lucent, for example. But the New York Times prints the tables so that the stocks can be found – after years of practice – in the proper places. If they were listed in some other order, it would take me a lot longer to read about stocks.
Another effect of the stroke in my case, has to do with the absolute inability to bring a name to mind. I sat here this morning unable to call the name of the Kessler Institute which I attended for rehabilitation services. Judy finally told me what it was. For several months and years, I could not recall the word “persimmon.” There are dozens of names like that as well as people and place names that may not come to mind easily. So I keep a booklet by the chair where I read that is filled with names that at one time I have forgotten. My latest entry is mysterium iniquitatis which the Pope said described the current travail of the priests and bishops in his flock. The translation is Mystery of Evil. I’m not so sure that this whole sorry mess is a mystery to anyone except to the hierarchy of the church.
On other occasions, I can recall names and conversations that took place 60 or more years ago. On the “We Have a Boy” essay, there are two routing slips posted on the letter that Ed Carr was the boy in question. Those routing slips contain about 22 names and the memo was written more than 60 years ago. I can recall every one of those men whose names appear on the routing slips but of course, I had the slips to remind me. I can recall their faces and many of their characteristics.
And then there is the problem that a sentence can be started either in speaking or in writing, without knowing how that sentence may be finished. I used to think in full paragraphs when delivering a speech or in bargaining proposals or in dealing with government bureaucrats. Now often when I start a sentence, it is a matter of considerable interest to see how the sentence is completed. Sort of a thrill a minute.
Of course, the foregoing areas of concern make the speaker or the writer a little hesitant to go forward. But at the end of the day, the ability to laugh at oneself is a saving grace. One way or another, things will work out so despair is out of the question. If that elderly gentleman on our street can jump from age 78 to 80 years of age, I would mark that off to good luck or the mystery of evil. But he exuded good cheer and it was pleasant to talk to him.
I wrote this little essay fearing that some may not want to hear of this old soldier’s troubles. That is not the point. The essay has been constructed so that a stroke sufferer or people close to her or him may have an idea of what to expect when the stroke becomes history. Immediately after the stroke, it would have been helpful to me to have an idea of what sort of problems might come into view down the road. And it would have been helpful to know that there are ways around the failure to bring to mind the name of an object. I use synonyms quite often. Sometimes a foreign thought takes a great purchase on my brain so much so that other thoughts are lost. Let’s say that “sugar” for example, gets stuck in my brain. In time “sugar” will go away. Patience is needed and I don’t have much of that virtue but as I say, with a little bit of luck and good rehabilitation work, and writing lots of essays, as well as a good sense of humor, it will all probably work out at the end of the day.
So as I told that gentleman on our street, he should stay strong. And he should not hang around out in the street. But at 79 or 82 years of age, I suppose he can do anything he wants.
E. E. CARR
April 13, 2002
Note¹: Ms. Chicka recalls that, at the writer’s insistence, we were really in the process of flipping the mattress, not simply making the bed.
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The family saying is that Shepherds never suffer in silence — maybe it should be amended to include the fact that Carrs tend to soldier through. Pop coped admirably with a lot of really awful hands, late in life, and his attitude generally matched what he described above. He’d do what he needed to do to keep going as best he could. I wonder if he ever stopped considering the essays a form of exercise, or if the distinction between a hobby and exercise simply failed to be meaningful after a while.